Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2015; 21(16): 4919-4924
Published online Apr 28, 2015. doi: 10.3748/wjg.v21.i16.4919
Proton-pump inhibitors for prevention of upper gastrointestinal bleeding in patients undergoing dialysis
Young Rim Song, Hyung Jik Kim, Jwa-Kyung Kim, Sung Gyun Kim, Sung Eun Kim
Young Rim Song, Hyung Jik Kim, Jwa-Kyung Kim, Sung Gyun Kim, Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Kidney Research Institute, Hallym University College of Medicine, Anyang-si 431-070, South Korea
Sung Eun Kim, Division of Gastroenterology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si 431-070, South Korea
Author contributions: Song YR and Kim HJ contributed equally to this work; Song YR and Kim SE designed the research; Song YR, Kim HJ, Kim JK, Kim SG, and Kim SE performed the research; Song YR and Kim SE analyzed the data; and Song YR and Kim HJ wrote the manuscript.
Supported by Grant from Hallym University Medical Center Research Fund.
Conflict-of-interest: The authors have no conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sung Eun Kim, MD, PhD, Division of Gastroenterology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 896, Pyeongchon-dong, Dongan-gu, Anyang-si 431-070, South Korea. sekim@hallym.or.kr
Telephone: +82-31-3803705 Fax: +82-31-3862269
Received: October 21, 2014
Peer-review started: October 27, 2014
First decision: November 14, 2014
Revised: December 2, 2014
Accepted: February 12, 2015
Article in press: February 13, 2015
Published online: April 28, 2015
Processing time: 188 Days and 1.6 Hours
Abstract

AIM: To investigate the preventive effects of low-dose proton-pump inhibitors (PPIs) for upper gastrointestinal bleeding (UGIB) in end-stage renal disease.

METHODS: This was a retrospective cohort study that reviewed 544 patients with end-stage renal disease who started dialysis at our center between 2005 and 2013. We examined the incidence of UGIB in 175 patients treated with low-dose PPIs and 369 patients not treated with PPIs (control group).

RESULTS: During the study period, 41 patients developed UGIB, a rate of 14.4/1000 person-years. The mean time between the start of dialysis and UGIB events was 26.3 ± 29.6 mo. Bleeding occurred in only two patients in the PPI group (2.5/1000 person-years) and in 39 patients in the control group (19.2/1000 person-years). Kaplan-Meier analysis of cumulative non-bleeding survival showed that the probability of UGIB was significantly lower in the PPI group than in the control group (log-rank test, P < 0.001). Univariate analysis showed that coronary artery disease, PPI use, anti-coagulation, and anti-platelet therapy were associated with UGIB. After adjustments for the potential factors influencing risk of UGIB, PPI use was shown to be significantly beneficial in reducing UGIB compared to the control group (HR = 13.7, 95%CI: 1.8-101.6; P = 0.011).

CONCLUSION: The use of low-dose PPIs in patients with end-stage renal disease is associated with a low frequency of UGIB.

Keywords: Dialysis; End-stage renal disease; Peptic ulcer; Gastrointestinal hemorrhage; Proton pump inhibitors

Core tip: Patients with end-stage renal disease are at a high risk for upper gastrointestinal bleeding (UGIB). The aim of this study was to assess the effects of low-dose proton-pump inhibitors (PPIs) for the prevention of UGIB in a cohort of patients with end-stage renal disease who began dialysis at our center between 2005 and 2013. The cumulative non-bleeding survival showed that the probability of UGIB was significantly lower in the PPI group than in the controls. PPI use was beneficial in reducing UGIB compared to the control (HR = 13.7, 95%CI: 1.8-101.6; P = 0.011).